Nurses fail to object to Dr.'s mid-forceps delivery.

CASE ON POINT: Daniels v. Durham County Hospital Corp., 615 S.E. 2d 60 -NC.

ISSUE: Should Nurses be held liable for tragic outcomes?

CASE FACTS: On September 1, 1995, Tonya Koonce-Daniels was admitted to Durham Regional Hospital by her private physician, Dr. James Dingfelder, for induction of labor. At approximately 7:30 a.m., the patient received an epidural to address her labor pains. Her labor continued through the afternoon without any signs of fetal distress or maternal compromise. At 3:55 p.m., the patient was in the second stage of labor, the point at which she would normally push the baby down further into the birth canal to complete a normal vaginal delivery. Nurse Clara Butler Sharpe, an employee of the hospital had come on duty as the patient's primary labor and delivery nurse. She had worked with Dr. Dingfelder for over 18 years. Nurse Sharpe assessed the patient and noted that her vital signs were "stable" and that the baby's heart rate was "normal." Dr. Dingfelder, however, performed a vaginal examination and determined that the baby was in an "occiput posterior" position. Dr. Dingfelder made a decision to perform a forceps delivery rather than allow the patient to begin pushing and attempt a normal vaginal delivery. At this point, the baby was at a "plus-two" station in the birth canal, her head not being visible during contractions. Thus a forceps delivery at this stage was characterized as a mid-forceps delivery. Dr. Dingfelder rotated the baby 180 degrees to the proper anterior position to deliver the baby assisted by Nurse Sharpe and Nurse Kay Parker, who was also an employee of the hospital When the baby was delivered at 4:18 p.m., she was unresponsive, blue in color, and not breathing Examination revealed that she had been born with a cervical spine injury. She was paralyzed from the neck down and unable to breathe on her own. The baby died from the spinal injury on April 11, 1996. The patient and her husband brought suit individually and on behalf of the estate of the deceased child. The plaintiffs voluntarily dismissed their suit against the hospital and later entered into a settlement agreement with Dr. Dingfelder. On February 11, 1999, the plaintiffs re-filed their suit against the hospital, asserting claims for negligence and negligent infliction of emotional distress. The Durham County Superior Court granted the hospital's motion for summary judgment. The plaintiffs appealed.

COURT'S OPINION: The North Carolina Court of Appeals affirmed the judgment of the lower court. The court held, inter alia, that, assuming arguendo that the hospital breached its duty by failing to have proper policies in place for such deliveries, the plaintiffs would have had to present evidence that such a breach was a ":contributing factor" to the baby's injuries and ultimate. The court held that without evidence of what a proper policy would have stated, it was impossible to determine whether such a policy would have precluded the delivery in this case and thus whether the lack of a policy was a contributing factor to the baby's injuries. The court held that the trial court properly entered summary judgment for the hospital based on (1) the lack of evidence presented by the plaintiffs; (2) the lack of a duty for a hospital or its nurses to obtain the informed consent of a patient receiving care from private physician; and (3) the lack of evidence as to the contents of the policy that the plaintiffs contended that the hospital negligently failed to adopt.

LEGAL COMMENTARY: The court rejected the plaintiffs' contention that Nurses Sharpe and Parker were negligent in following Dr. Dingfelder's instructions. Nurses, in the discharge of their duties, must obey and diligently execute the orders of the physician or surgeon in charge of the patient, unless, of course, such order is so obviously negligent as to lead any reasonable person to anticipate that substantial injury would result to the patient from the execution of such order or performance of such direction. Certainly, if a physician or surgeon should order a nurse to stick fire to a patient, no nurse would be protected from liability for damages for undertaking to carry out the orders of the physician. The law contemplates that the physician is solely responsible for the diagnosis and treatment of his patient. Nurses are not supposed to be experts in the technique of diagnosis or the mechanics of treatment. The court concluded that although the facts in the case are tragic, the plaintiffs settled and dismissed their claims with prejudice against Dr. Dingfelder, without any admission or finding of liability by him. In asserting their claims against the hospital and its nurses, the court found that the plaintiffs failed to forecast evidence to show a separate duty imposed on the nurses or the hospital.

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Rhode Island firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's, Nursing Laws & Hospital Law's Regan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, Who's Who in America and Who's Who in the World.